Provider Demographics
NPI:1134512130
Name:LEE, BIANCA LAVONNE (LCPC)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:LAVONNE
Last Name:LEE
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12213 MALTA LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1811
Mailing Address - Country:US
Mailing Address - Phone:480-518-1336
Mailing Address - Fax:
Practice Address - Street 1:4450 MITCHELLVILLE RD # 1065
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3112
Practice Address - Country:US
Practice Address - Phone:443-500-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6188101YP2500X
MDLC82222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional